Defeating prostate cancer

Dear Dr Ren:

I am a 52-year-old gay man. When I was diagnosed with prostate cancer, I was badly shaken. Recently, I was told that my cancer would require surgery. Now, I am shaking! James, my partner of eight years, and I are very close and sexually very active. He has been nothing but supportive and loving during this experience, but he admits that he is as afraid of the possible consequences of my surgery as I am.

Frankly, we don’t really know what to expect and we’re having trouble separating truth from myth. Please help us understand what is about to happen to me-and to us. How should I prepare for this surgery? How long will it take me to recover? What is the best way for James to see me through this? What will happen to our relationship in general and our sex life in particular (I’m the bottom)? Will I lose my desire or my ability to have an erection? Please, give us the facts.

Terrified

Dear Terrified:

I applaud you and your health care providers for sound medical care. Many men your age have not even thought of having their prostates checked. I suspect it was during a physical exam that your doctor discovered a high PSA (prostate specific antigen) score or a growth on your prostate gland. You are lucky to have caught it early.

Preparation for your surgery involves gathering information so that you encounter as few surprises as possible. You will need care as you recover and must be willing to accept it. You and James would do well to discuss these roles prior to your hospitalization.

Do not expect a rapid recovery. Have patience. Allow a year or more to assess your full recovery, though you won’t be laid-up nearly that long.

You will experience incontinence and impotence immediately after the surgery. The incontinence will resolve, but regaining your ability to have an erection depends on a number of factors: primarily your age, the size of your tumour, and the type of surgery you undergo.

For men under the age of 50, fewer than 10 percent permanently lose erectile capacity. That number swells to 25 percent for those between 50 and 60 years of age and to between 40 and 45 percent for men between 60 and 70. Men above 70 years of age suffer an impotence rate of almost 75 percent. As you can see, your age is in your favour.

You did not mention the size or stage of your tumour, though your medical team can surely provide this information. If your tumour is stage A or B, you have half the risk of erectile failure that you do if you have later-stage growth. This is because blood supply is a key determinant of your ability to have an erection and excision of larger tumours requires more invasive surgery that involves more blood vessels.

Erectile competence is preserved in about 60 percent of nerve-sparing surgeries, but when nerves must be sacrificed, erectile competence is preserved in 35 to 40 percent of cases.

Sometimes only one nerve bundle is spared. Surgeons do the best they can with what they have to work with. Talk with your doctors about their surgical plans.

After your recovery, your erections may not be as reliable or as firm, and you may have to work harder to achieve them. You will experience retrograde (dry) ejaculations and your orgasms may feel different than before.

Sex will not be the same as it was. As a bottom your situation is somewhat easier than if you were a top, but you will need to adjust your sexual rhythm to accommodate genitals that behave differently; we all do as years and circumstances change our abilities and desires.

Once you regain your physical health, you will find your sexual desire unaffected, but your relationship with James may have undergone a power shift due to his taking care of you. You will need to re-establish your independence as you recover. If you have prepared for this during your convalescence, it should not be a problem. Many hospitals offer valuable support groups to help couples through this difficult phase.

Do not allow prostate cancer to define you. You must be careful not to lose your identity to your illness. Encourage James to enjoy a life other than as your caretaker. As you return to good health, remain as engaged in social activities as you can.

In time you will be cancer-free, and your body will regain urinary and, probably, erectile control. You and James will learn important lessons about each other. You will be better prepared for life’s next challenge. Fifty years ago, this would have been a death sentence, today it is an uncomfortable medical procedure.

Keep your perspective and be thankful for every day.